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Berthold DP, Polzer H, Baumbach SF. Letter Regarding: CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review. Foot Ankle Int 2024; 45:419-420. [PMID: 38651665 DOI: 10.1177/10711007241230321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
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Ehrnthaller C, Rellensmann K, Baumbach SF, Wuehr M, Schniepp R, Saller MM, Böcker W, Polzer H. Pedobarographic evaluation of five commonly used orthoses for the lower extremity. Arch Orthop Trauma Surg 2023; 143:4249-4256. [PMID: 36571629 PMCID: PMC10293377 DOI: 10.1007/s00402-022-04729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Orthoses are designed to achieve immobilization or off-loading of certain regions of the foot. Yet, their off-loading capacity for the specific regions has not yet been studied. Therefore, the aim of this study was to analyze the plantar pressure distribution of five commonly applied orthoses for foot and ankle in a healthy population. MATERIALS AND METHODS Five orthoses (postoperative shoe, forefoot relief shoe, short walker boot, high walker boot, and calcaneus fracture orthosis) were compared pedobarographically using insoles on a treadmill to a ready-made running shoe in eleven healthy subjects (median age 29 years). Peak pressure, maximum force, force-time integral, contact time, and contact area were evaluated separately for the forefoot, midfoot, and hindfoot. RESULTS The forefoot relief shoe, the short- and high walker boot significantly reduced the peak pressure at the forefoot with no significant differences between these orthoses. None of the five orthoses off-loaded the midfoot, but the calcaneus fracture orthosis and the short walker boot instead increased midfoot load. For the hindfoot, the calcaneus fracture orthosis was the only device to significantly reduce the peak pressure. CONCLUSIONS This is the first study to investigate the specific off-loading capacities of different orthoses for specific foot regions in a healthy collective. The knowledge of absolute and relative load shifts for the different orthoses is of fundamental interest for targeted clinical decision-making of physicians.
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Affiliation(s)
- C Ehrnthaller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - K Rellensmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - M Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - M M Saller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - W Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
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Baumbach SF, Böcker W, Polzer H. [Fractures of the talar neck and body : An overview]. Unfallchirurgie (Heidelb) 2023; 126:485-497. [PMID: 37225903 DOI: 10.1007/s00113-023-01330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
Fractures to the talar neck and talar body (central talar fractures) are rare injuries but often result in devastating outcomes. It is therefore important to diagnose these injuries early and provide the best possible treatment. The analysis, classification, and surgical planning of central talar fractures should be based on computed tomography (CT) imaging. In the case of dislocated fractures, surgeons must strive for an anatomic reduction and fixation. The approach routes are based on the fracture morphology and must enable adequate reduction of the fracture. This can often only be achieved by two or more approach routes. The outcome correlates with fracture complexity and the quality of the reduction. Complications such as avascular necrosis and posttraumatic osteoarthritis are common and have a negative effect on the results of the treatment.
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Affiliation(s)
- Sebastian F Baumbach
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstraße 5, 80336, München, Deutschland
| | - Wolfgang Böcker
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstraße 5, 80336, München, Deutschland
| | - Hans Polzer
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstraße 5, 80336, München, Deutschland.
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Baumbach SF, Rellensmann K, Spindler FT, Böcker W, Barg AD, Mittlmeier T, Ochman S, Rammelt S, Polzer H. Immediate weight bearing without immobilization for operatively treated ankle fractures is safe - A systematic review. Foot Ankle Surg 2023; 29:306-316. [PMID: 37076381 DOI: 10.1016/j.fas.2023.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/26/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND This systematic literature review compared weight bearing (WB) vs. partial- / non-weight bearing (NWB) and mobilization (MB) vs. immobilization (IMB) for surgically treated ankle fractures. METHODS Five databases were searched. Eligible were (quasi-)randomized controlled trials comparing at least two different postoperative treatment protocols. The risk of bias was assessed using the RoB-2 toolkit. The primary outcome was complication rate, secondary outcome Olerud and Molander Ankle Score (OMAS), range of motion (ROM), and return to work (RTW). RESULTS Out of 10,345 studies, 24 papers were eligible. Thirteen studies (n = 853) compared WB/NWB, 13 studies (n = 706) MB/IMB with a moderate study quality. WB did not increase the risk for complications but resulted in superior short-term outcomes for OMAS, ROM, RTW. 12 studies found no inferior results for MB compared to IMB. CONCLUSION Early and immediate WB and MB do not increase the complication rates but result in superior short term outcome scores. LEVEL OF EVIDENCE Level I Systematic Review.
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Affiliation(s)
- S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich 80336, Germany
| | - K Rellensmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich 80336, Germany
| | - F T Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich 80336, Germany
| | - W Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich 80336, Germany
| | - A D Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, Rostock 18057, Germany
| | - S Ochman
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Westfalian Wilhems University Muenster, Albert Schweitzer Campus 1, W1, Muenster 48149, Germany
| | - S Rammelt
- University Center for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany
| | - H Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich 80336, Germany.
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Spindler FT, Gaube FP, Böcker W, Polzer H, Baumbach SF. Value of Intraoperative 3D Imaging on the Quality of Reduction of the Distal Tibiofibular Joint When Using a Suture-Button System. Foot Ankle Int 2023; 44:54-61. [PMID: 36537750 PMCID: PMC9834319 DOI: 10.1177/10711007221138775] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The quality of reduction of the distal tibiofibular joint (DTFJ) has a major impact on the outcome. Novel suture-button systems as well as intraoperative 3D imaging can be applied to increase the quality of DTFJ reduction intraoperatively. The individual effect of either remains unknown. The aim of this study was to investigate the value of intraoperative 3D imaging on the quality of reduction of the DTFJ when using a suture-button system. METHODS Retrospective, radiographic study including adult patients who underwent surgical stabilization of the syndesmosis with a suture-button system for acute, unilateral, unstable syndesmotic injuries with postoperative bilateral CT imaging. The use of an intraoperative 3D scan was the individual surgeon's choice. Assessed was whether the intraoperative 3D imaging had an influence on the postoperative quality of DTFJ reduction and revision rates. These findings were put in perspective to the correction potential of the suture-button system. RESULTS A total of 147 patients were included; 76 of these received an intraoperative 3D imaging. Neither the rate of formal malreduction (17% vs 17%) nor the postoperative revision rate (4% vs 3%) differed significantly between patients with or without intraoperative 3D imaging. Intraoperative 3D imaging revealed a false-negative rate of 14%. The intrinsic correction potential of the suture-button system reduced the number of formally malreduced DTFJs in both groups by 51%. CONCLUSION The additional value of intraoperative 3D imaging to assess the quality of DTFJ reduction in our series did not improve syndesmotic reduction when using a flexible suture-button system. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Fabian T. Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Federico P. Gaube
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Sebastian F. Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
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Harrasser N, Hinterwimmer F, Baumbach SF, Pfahl K, Glowalla C, Walther M, Hörterer H. The distal metatarsal screw is not always necessary in third-generation MICA: a case-control study. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04740-7. [PMID: 36577799 PMCID: PMC10374712 DOI: 10.1007/s00402-022-04740-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron-Akin osteotomy (MICA) for hallux valgus deformities. MATERIALS AND METHODS Between August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II-V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months. RESULTS Displacement of MTH was 70-90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation. CONCLUSIONS Fixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.
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Affiliation(s)
- Norbert Harrasser
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - F Hinterwimmer
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - K Pfahl
- FIFA Medical Centre, Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
| | - C Glowalla
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - M Walther
- FIFA Medical Centre, Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
| | - H Hörterer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- FIFA Medical Centre, Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
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Hofmann-Kiefer KF, Gaube F, Groene P, Böcker W, Polzer H, Baumbach SF. "High ankle block" for surgery at the ankle joint. Foot Ankle Surg 2022; 28:1254-1258. [PMID: 35654730 DOI: 10.1016/j.fas.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgery around the ankle is increasingly embedded in outpatient treatment concepts. Unfortunately, the classic "ankle block" as a concept of regional anesthesia is inappropriate for surgery around the ankle because the injection sites are too distal to block this specific region. METHODS The "high ankle block" avoids this disadvantage by dislocating the injection points 15 cm proximal to the malleoli. Three of five peripheral nerves necessary to perform the block can be reached by a circumferential subcutaneous wall. The Posterior Tibial Nerve and the Deep Peroneal Nerve are addressed by an ultrasound guided approach. RESULTS The efficacy of the technique is highlighted by a case series (3 cases) in which the new blockade was used as a stand-alone procedure, i.e. without additional general anesthesia. CONCLUSIONS The "high ankle block" may serve as an ultrasound guided expansion to the classic techniques, extending the operative spectrum to the ankle region.
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Affiliation(s)
- Klaus F Hofmann-Kiefer
- Clinic of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Munich, Ludwig Maximilians University of Munich, Germany.
| | - Federico Gaube
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Philipp Groene
- Clinic of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Munich, Ludwig Maximilians University of Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Sebastian F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
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8
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Spindler FT, Gaube FP, Böcker W, Polzer H, Baumbach SF. Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis. Foot Ankle Int 2022; 43:1393-1401. [PMID: 35942915 PMCID: PMC9643819 DOI: 10.1177/10711007221115193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is an ongoing discussion on how to best stabilize syndesmotic injuries. Previous studies have indicated a better quality of reduction of the distal tibiofibular joint (DTFJ) for the suture button systems compared to syndesmotic screw fixation. Still, the reason for this superiority remains unclear. The aims of this retrospective study were to (1) analyze the deviation of the tibial and fibular drilling tunnels of the suture button system and (2) to compare these to the quality of reduction of the DTFJ assessed on bilateral postoperative CT images. METHODS Included were all adult patients who underwent syndesmotic stabilization for an acute injury using a suture button system, with postoperative, bilateral CT imaging over a 10-year period. A total of 147 patients were eligible. Based on individually reconstructed axial CT slices, the postoperative quality of reduction of the DTFJs was rated on bilateral CT images. Furthermore, the rotation and translation of the suture button drilling tunnels were analyzed. Based on these measurements, the intraoperative reduction of the DTFJ was recalculated and again rated. Using these values, the correction potential of suture button systems on the reduction of the DTFJ was analyzed. RESULTS (1) The drilling tunnel deviated considerably for both rotation |2.3±2.1 degrees| (range: |0.0-13.1 degrees|) and translation |0.9±0.8 mm| (range: |0-4.3 mm|). Based on the deviation of the drilling tunnels in fibula and tibia, the calculated intraoperative reduction of the DTFJ was classified as malreduced in 35.4%. (2) The DTFJ was postoperatively identified as malreduced in 17% of patients. Overall, the suture button system tended to compensate toward a more anatomical reduction both in the axial and sagittal plane. CONCLUSION A suture button system postoperatively deviates and apparently has the capacity to compensate for intraoperative malreduction. Analysis of the drilling tunnels revealed that the use of a rigid fixation system would have doubled the postoperative malreduction rate.
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Affiliation(s)
- Fabian T. Spindler
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
| | - Federico P. Gaube
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany,Hans Polzer, MD, Department of Orthopaedics
and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University
Hospital, LMU Munich, Ziemssenstraße 5, Munich, 80336, Germany.
| | - Sebastian F. Baumbach
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
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Spindler FT, Herterich V, Holzapfel BM, Böcker W, Polzer H, Baumbach SF. A systematic review and meta-analysis on the value of the external rotation stress test under fluoroscopy to detect syndesmotic injuries. EFORT Open Rev 2022; 7:671-679. [PMID: 36287127 PMCID: PMC9619390 DOI: 10.1530/eor-22-0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- F T Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - V Herterich
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - B M Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - W Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - H Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany,Correspondence should be addressed to H Polzer;
| | - S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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10
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Buchhorn T, Baumbach SF, Böcker W, Szymski D, Polzer H. [Salvage options following failed total ankle arthroplasty]. Unfallchirurg 2022; 125:211-218. [PMID: 35091802 DOI: 10.1007/s00113-022-01141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. The most frequent reasons for revision of an ankle prosthesis are aseptic loosening, technical implantation errors and persisting pain. For the revision of an ankle prosthesis there are basically two treatment options. For a long time, ankle arthrodesis was considered the gold standard after a failed prosthesis. In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.
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Affiliation(s)
- T Buchhorn
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland
| | - S F Baumbach
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - W Böcker
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - D Szymski
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland.,Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland
| | - H Polzer
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland.
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11
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Moellhoff N, Polzer H, Baumbach SF, Kanz KG, Böcker W, Bogner-Flatz V. [Unguis incarnatus-conservative or operative treatment? A practical treatment algorithm]. Unfallchirurg 2021; 124:311-318. [PMID: 33111185 PMCID: PMC7985053 DOI: 10.1007/s00113-020-00903-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/02/2022]
Abstract
Unguis incarnatus, an ingrown toenail, is a common condition in primary care, which is encountered by various medical professions. Inconsistent conservative treatment and nonindicated surgical treatment often result in complications and recurrence of the disease. Patients must be thoroughly informed about the complexity of the nail organ. This is a prerequisite to prevent trivialization of the disease and to achieve appropriate patient compliance for treatment. In this article a practical diagnostic and treatment algorithm for unguis incarnatus is presented. In mild cases of acute unguis incarnatus a consistent conservative treatment is the first-line strategy showing promising results. In cases of moderate to severe forms of acute unguis incarnatus, surgical procedures that preserve the nail matrix should be applied. For cases of chronic unguis incarnatus without an acute infection, elective partial matrixectomy can be indicated. Prior to any surgical intervention, detailed informed consent must be obtained from the patients.
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Affiliation(s)
- N Moellhoff
- Abteilung für Hand‑, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - H Polzer
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - S F Baumbach
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - K G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - V Bogner-Flatz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
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Baumbach SF, Urresti-Gundlach M, Braunstein M, Borgmann L, Böcker W, Vosseller JT, Polzer H. Propensity Score-Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment. Foot Ankle Int 2021; 42:400-408. [PMID: 33327772 PMCID: PMC8056703 DOI: 10.1177/1071100720969609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the prospective, longitudinal outcome after arthroscopically assisted open reduction and internal fixation (AORIF) and to compare the results with open reduction and internal fixation (ORIF) in complex ankle fractures. METHODS Acute, closed, bimalleolar equivalent, bimalleolar, or trimalleolar ankle fractures were included. The AORIF cohort was enrolled prospectively. The ORIF group was identified from a retrospective database. The same inclusion and exclusion criteria were applied. The only difference was the additional arthroscopy in the AORIF cohort. The patient-reported outcome measurement (PROM) following AORIF was assessed at 1 and 4 years of follow-up using the Olerud and Molander Ankle Score (OMAS) and Tegner activity scale (TAS). The AORIF cohort was propensity score matched (nearest-neighbor matching) to the ORIF database. The OMAS and Foot and Ankle Ability Measure (FAAM) were compared between the resulting groups. Nonparametric statistics were applied; values are presented as median (interquartile range). Twenty-six AORIF patients had a prospective 4-year follow-up. RESULTS No significant differences (1 year vs 4 years) were identified for the OMAS (90 [10] vs 90 [11]) and TAS (4 [2] vs 5 [2]). The severity of the cartilage lesions (International Cartilage Repair Society [ICRS] grade <4 vs ICRS of 4) had no significant influence on the PROMs. Twenty-five patients per cohort (AORIF vs ORIF) were matched. The OMAS (90 [13] vs 75 [40]; P = .008) and FAAM Activities of Daily Living (ADL; 96 [11] vs 88 [30]; P = .034) revealed significantly better outcomes for AORIF. More patients in the AORIF cohort returned to sport (96% vs 77%; P = .035), with a higher FAAM Sports score (88 [37] vs 56 [47]; P = .008). CONCLUSION AORIF for complex ankle fractures led to consistently good to excellent results. The propensity score-matched analysis revealed a significantly better outcome 4 years after surgery for AORIF compared with ORIF. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sebastian F. Baumbach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - Marcel Urresti-Gundlach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - Mareen Braunstein
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - Lars Borgmann
- Center for Higher Education, TU Dortmund University, Dortmund, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany
| | - J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA,Hans Polzer, MD, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, Munich, 80336, Germany.
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Rellensmann K, Baumbach SF, Polzer H. [28/f-Ankle sprains: not always are the lateral ligaments injured : Preparation for the medical specialist examination: part 64]. Unfallchirurg 2021; 124:179-183. [PMID: 33620519 DOI: 10.1007/s00113-021-00961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Kathrin Rellensmann
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nussbaumstr. 20, 80336, München, Deutschland
| | - Sebastian F Baumbach
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nussbaumstr. 20, 80336, München, Deutschland
| | - Hans Polzer
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nussbaumstr. 20, 80336, München, Deutschland.
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Braunstein M, Baumbach SF, Urresti-Gundlach M, Borgmann L, Böcker W, Polzer H. Arthroscopically Assisted Treatment of Complex Ankle Fractures: Intra-articular Findings and 1-Year Follow-Up. J Foot Ankle Surg 2020; 59:9-15. [PMID: 31882154 DOI: 10.1053/j.jfas.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/05/2019] [Accepted: 05/11/2019] [Indexed: 02/03/2023]
Abstract
Especially after complex ankle fractures, patients regularly suffer from residual symptoms, presumably due to occult intra-articular injuries. The aim of this study was to evaluate the intra-articular lesions, identify fractures specifically at risk for these, and assess the results after arthroscopically assisted open reduction and internal fixation of complex ankle fractures after 1 year. The primary outcome was the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Secondary outcome parameters were the Olerud and Molander Ankle Score (OMAS), Tegner activity scale, arthroscopic findings, functional assessment, and complications. Thirty-two patients (56% female) were enrolled. Chondral lesions were detected in 91%. Full-thickness lesions treated by microfracturing were observed in 0% of unimalleolar, 43% of bimalleolar, and 40% of trimalleolar fractures. After 1 year, the median (interquartile range) AOFAS was 94 (9) and OMAS was 90 (10) for all patients. When analyzing factors possibly influencing the outcome, age, sex, smoking, grading for surgical procedures according to the American Society of Anesthesiologists, fracture type (uni-, bi-, or trimalleolar), severity of chondral lesions graded according to the International Cartilage Repair Society (grade <4 versus grade 4), and syndesmotic instability had no significant influence on the outcome. The only variable significantly influencing the AOFAS (p = .004) and OMAS (p < .001) was body mass index (BMI; rs = -0.522 and -0.606, respectively), with a higher BMI resulting in inferior outcome scores. Complications were observed in 3 patients, 2 with superficial skin necrosis at the posterolateral incision and 1 nonunion of the medial malleolus. Taken together, these data show that intra-articular injuries were common in ankle fractures. Bi- and trimalleolar fractures were particularly at risk for full-thickness lesions. A higher BMI tended to result in inferior outcome scores. Arthroscopically assisted open reduction and internal fixation led to good to excellent results in all but 1 patient.
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Affiliation(s)
- Mareen Braunstein
- Associate Registrar, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Sebastian F Baumbach
- Surgeon, Associate Professor, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Marcel Urresti-Gundlach
- Associate Registrar, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Lars Borgmann
- Data Scientist, Center for Higher Education, TU Dortmund University, Dortmund, Germany
| | - Wolfgang Böcker
- Surgeon, Professor, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany
| | - Hans Polzer
- Surgeon, Associate Professor, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Munich, Germany.
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Abstract
BACKGROUND Fractures of the fifth metatarsal base (5th MT) are common foot injuries, but their treatment remains a subject of debate. The aim was to assess the midterm outcome of functionally treated epi-metaphyseal fractures (Lawrence and Botte types I and II) of the 5th MT. METHODS This study was a longitudinal retrospective database study with prospective follow-up. Included were all patients with an acute, isolated fracture to the 5th MT base (types I and II). All patients were treated functionally: weightbearing as tolerated without immobilization. Fracture types and fracture characteristics (displacement <2 mm/>2 mm, articular involvement, number of fragments) were assessed retrospectively. Patient-reported outcome measures (PROMs) including the visual analog scale for foot and ankle (VAS FA) and the quality-of-life score (QoL) SF-12 were collected prospectively at 2- and 5-year follow-up. Out of 95 patients, 43 patients (45%) were included with a median follow-up of 5.7 (1.5) years. RESULTS For both the VAS FA and SF-12, excellent scores were observed. For 30 patients (77%), longitudinal 2- and 5-year follow-up was available. No significant longitudinal changes could be observed for the VAS FA and SF-12. For both time points, neither fracture type nor characteristics significantly influenced any outcome parameter assessed. CONCLUSION Functional treatment by full weightbearing and free range of motion led to excellent 5-year results for both type I and II fractures. Neither fracture location nor characteristics had a significant influence on the 5-year PROMs. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Sebastian F. Baumbach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Marcel Urresti-Gundlach
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - J. Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA,Hans Polzer, MD, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, Munich, 80336, Germany.
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Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J. How We Manage Bone Marrow Edema-An Interdisciplinary Approach. J Clin Med 2020; 9:jcm9020551. [PMID: 32085459 PMCID: PMC7074543 DOI: 10.3390/jcm9020551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.
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Affiliation(s)
- Sebastian F. Baumbach
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Vanessa Pfahler
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Susanne Bechtold-Dalla Pozza
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Pediatric Endocrinology and Diabetology, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Isa Feist-Pagenstert
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Julian Fürmetz
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Andrea Baur-Melnyk
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulla C. Stumpf
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Maximilian M. Saller
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-University (LMU), Fraunhoferstraße 20, 82152 Planegg-Martinsried, Germany
| | - Andreas Straube
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ralf Schmidmaier
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department for Endocrinology and Diabetology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Ziemssenstraße 1, 80336 Munich, Germany
- Correspondence: (R.S.); (J.L.); Tel.: +49-89-4400-52101 (R.S.); Fax: +49-89-4400-54410 (R.S.)
| | - Jan Leipe
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Ziemssenstraße 1, 80336 Munich, Germany
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University Heidelberg, Ludolf-Krehl-Straße 13–17, 68167 Mannheim, Germany
- Correspondence: (R.S.); (J.L.); Tel.: +49-89-4400-52101 (R.S.); Fax: +49-89-4400-54410 (R.S.)
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Massen FK, Baumbach SF, Herterich V, Böcker W, Waizy H, Polzer H. Fractures to the anterior process of the calcaneus - Clinical results following functional treatment. Injury 2019; 50:1781-1786. [PMID: 31178146 DOI: 10.1016/j.injury.2019.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fractures to the anterior process of the calcaneus (APC) have long been considered rare injuries. Although recent studies have reported a higher incidence, these injuries have yet received little attention in clinical research. Only few case reports/series, all suffering multiple methodical shortcomings, exist. The aim of this study was to objectively evaluate the outcome after fractures to the APC treated by full weight bearing and to investigate the influence of fracture characteristics. METHODS Retrospective register study with prospective follow-up. Adults with acute unilateral fractures to the APC and concomitant injuries limited to the Chopart joint line, treated by full weight-bearing, with a follow-up of ≥ 12 months were included. Fracture characteristics (Degan classification, displacement, intra-articular involvement, comminution) were assessed in CT scans. Return to work (RTW) / sports (RTS), Visual Analogue Scale Foot and Ankle (VAS-FA), Karlsson Score and the 12-Item Short-Form Health Survey (SF-12) were assessed. The influence of age, sex, fracture type/characteristics, and concomitant injuries on the outcome parameters was analyzed. RESULTS 27 patients (38 years, IQR 29-58), 74% female with a median follow up of 24 months (IQR 16-41) were included. 56% of the fractures were non-displaced and 82% comminuted. 48% were type I, 33% type II and 19% type III according to Degan. 78% of the patients suffered concomitant injuries of the Chopart joint line. Median RTW was 14 days (IQR 10-42), and RTS 90 days (IQR 30-180). The clinical outcome resulted in a median overall VAS-FA of 95 (IQR 89-98), Karlsson Score of 90 (IQR 82-100) and SF-12 PCS of 56 (IQR 53-58) / SF-12 MCS 55 (48-58). CONCLUSION Functional treatment of fractures to the anterior process of the calcaneus yielded good to excellent results and a fast return to work in the vast majority of patients. Yet, a prolonged return to sports was noted. No significant differences regarding the outcome were observed when comparing the different fracture types or any other fracture characteristic assessed.
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Affiliation(s)
- F K Massen
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany.
| | - S F Baumbach
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany.
| | - V Herterich
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany.
| | - W Böcker
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany.
| | - H Waizy
- Orthoprofis - Rueckenprofis, Luisenstraße 10-11, 30159 Hannover, Germany; Laboratory for Biomechanics und Biomaterials, Hannover Medical School, Haubergstr. 3, 30625 Hannover, Germany.
| | - H Polzer
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany.
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Baumbach SF, Braunstein M, Herterich V, Böcker W, Waizy H, Polzer H. [Arthroscopic repair of chronic lateral ankle instability]. Oper Orthop Traumatol 2019; 31:201-210. [PMID: 30918997 DOI: 10.1007/s00064-019-0595-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/03/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Repair of the lateral ligament complex of the ankle joint; identification and treatment of intra-articular pathologies. INDICATIONS Symptomatic chronic lateral ankle instability. Treatment of osteochondral lesions associated with lateral ankle instability. CONTRAINDICATIONS Osteoarthritis of the ankle joint, risk factors such as peripheral occlusive disease, diabetic foot syndrome, complex regional pain syndrome. SURGICAL TECHNIQUE Diagnostic arthroscopy of the ankle joint utilizing anterolateral and -medial portals; identification and treatment of intra-articular pathologies; identification and preparation of the distal fibula; insertion of two suture anchors; the sutures are passed inside-out through the joint capsule, the scarred lateral ligaments, the extensor retinaculum using a suture lasso; by tying down the sutures the tissue grasped is then pulled against the distal fibula; this will stabilize the lateral ligament complex. POSTOPERATIVE MANAGEMENT Partial weight-bearing and short leg cast for 2 weeks, then 4 weeks ankle brace and range of motion exercises, thereafter functional physical therapy, ankle brace only during exercises; no sports for at least 3 months. RESULTS Currently, one randomized controlled trial is available comparing open to arthroscopic lateral ankle ligament repair. Open repair was always combined with arthroscopy to treat intra-articular pathologies. In all patients, surgery led to a significant increase of the American Orthopaedic Foot and Ankle Score (AOFAS), Karlsson Score and visual analog score (VAS), but no significant differences between the open and arthroscopic procedure after one year with similar complications (arthroscopy group: 3 temporary nerve irritations and 2 patients with pain over the knot; open treated group: 2 temporary nerve irritations and one abscess). Intra-articular pathologies were treated in 68% of the arthroscopically treated patients and 70% of the patients treated by open surgery. One out of two retrospective comparative studies reported a significantly shorter operation time and time to return to daily activity and significantly lower VAS three days postoperatively for arthroscopically treated patients, while the other parameters assessed were comparable.
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Affiliation(s)
- S F Baumbach
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - M Braunstein
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - V Herterich
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - W Böcker
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland
| | - H Waizy
- Sektion für Fuß- und Sprunggelenkchirurgie, Donau-Ries Klinik Donauwörth, Neudegger Allee 6, 86609, Donauwörth, Deutschland
| | - H Polzer
- Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU München, Ludwig-Maximilians-Universität, Nußbaumstraße 20, 80336, München, Deutschland.
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Baumbach SF, Braunstein M, Mack MG, Maßen F, Böcker W, Polzer S, Polzer H. [Insertional Achilles tendinopathy : Differentiated diagnostics and therapy]. Unfallchirurg 2019; 120:1044-1053. [PMID: 28980027 DOI: 10.1007/s00113-017-0415-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Achilles tendinopathy at the calcaneal insertion is classified into insertional tendinopathy, retrocalcaneal and superficial bursitis. The aim of this study was to present the current evidence on conservative and surgical treatment of insertional tendinopathy of the Achilles tendon. Conservative first-line therapy includes reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization. In addition, further conservative therapy options are also available. Eccentric stretching exercises should be integral components of physiotherapy and can achieve a 40% reduction in pain. Extracorporeal shock wave therapy has been shown to reduce pain by 60% with a patient satisfaction of 80%. Due to the limited evidence, injections with platelet-rich plasma (PRP), dextrose (prolotherapy) or polidocanol (sclerotherapy) cannot currently be recommended. Operative therapy is indicated after 6 months of unsuccessful conservative therapy. Open debridement allows all pathologies to be addressed, including osseous abnormalities and intratendinous necrosis. The success rate of over 70% is contrasted by complication rates of up to 40%. The Achilles tendon should be reattached, if detached by >50%. No valid data are available for the transfer of the tendon of the flexor hallucis longus (FHL) muscle but it is frequently applied in cases of more than 50% debridement of the diameter of the Achilles tendon. Lengthening of the gastrocnemius muscle cannot be recommended because insufficient data are available. Tendoscopy is a promising treatment option for isolated retrocalcaneal bursitis and has shown similar success rates to open debridement with significantly lower complication rates.
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Affiliation(s)
- S F Baumbach
- Klinik für Allgemeine, Unfall‑, Hand- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - M Braunstein
- Klinik für Allgemeine, Unfall‑, Hand- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - M G Mack
- Radiologie München, München, Deutschland
| | - F Maßen
- Klinik für Allgemeine, Unfall‑, Hand- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall‑, Hand- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - S Polzer
- Praxis für Hand‑, Ellenbogen- und Fußchirurgie, ATOS-Klinik Heidelberg, Heidelberg, Deutschland
| | - H Polzer
- Klinik für Allgemeine, Unfall‑, Hand- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland.
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Baumbach SF, Herterich V, Damblemont A, Hieber F, Böcker W, Polzer H. Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability. Injury 2019; 50:564-570. [PMID: 30600086 DOI: 10.1016/j.injury.2018.12.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/03/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
AIM Comparison of unfixed, CRIF, and ORIF of the posterior malleolus fragment (PMF) regarding the frequency of trans-syndesmotic fixation and quality of reduction in trimalleolar (equivalent) fractures. MATERIAL AND METHODS Retrospective registry study. Patients with a trimalleolar (equivalent) ankle fractures were identified within the departments' fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the PMF treatment: not addressed, CRIF, ORIF. RESULTS 236 patients (53.0 ± 18.3 (range: 18-100) years), 58.1% female were eligible. The mean size of the PMF was 21.4 ± 10.4% (range: 2.7-55.9%), 71.6% were ≤25% of the tibial plafond. PMF fixation: Untreated 48.3%, CRIF 18.6%, ORIF 33.1%. ORIF of the PMF significantly (p < 0.001) reduced the frequency of trans-syndesmotic fixation (25%) compared to CRIF (61%) or untreated PMF (63%) with no significant influence of the PMF size (≤25%/>25%). ORIF resulted in a significantly (p < 0.001) better quality of reduction (1.2 ± 1.1 mm (range: 0-5 mm)) compared to CRIF (2.5 ± 2.1 mm (range: 0-8 mm)) and untreated PMF (2.5 ± 2.3 mm (range: 0-20 mm)). Neither the frequency of trans-syndesmotic fixation nor the quality of reduction differed significantly between untreated PMF and CRIF. CONCLUSION All posterior malleolus fragments, independent of their size, should be treated by ORIF, as this restores syndesmotic stability significantly more often than untreated PMF or CRIF.
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Affiliation(s)
- S F Baumbach
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany
| | - V Herterich
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany
| | - A Damblemont
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany
| | - F Hieber
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany
| | - W Böcker
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany
| | - H Polzer
- University Hospital, LMU Munich, Department of General, Trauma and Reconstructive Surgery, Nussbaumstr. 20, 80336 Munich, Germany.
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Hörterer H, Baumbach SF, Mehlhorn AT, Altenberger S, Röser A, Polzer H, Walther M. [Fractures of the lateral process of the talus-snowboarder's ankle]. Unfallchirurg 2018; 121:715-722. [PMID: 29959450 DOI: 10.1007/s00113-018-0519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Fractures of the lateral tubercle of the talus (PLT) are rare. With the increasing popularity of the trend sport snowboarding, the incidence of PLT fractures has increased. The most common classification of PLT fractures is the Hawkins classification. The aim of this review was to raise awareness for the injury and discuss the current evidence. A literature search revealed eight studies, each including at least seven patients. Six out of the eight studies were descriptive, retrospective case series without predefined treatment concepts. These resulted in only moderate treatment outcomes. Due to the low number of patients, the lack of computed tomography (CT) or magnetic resonance imaging (MRI) and inconsistent treatment approaches, these studies do not allow to draw conclusions on a treatment concept for PLT fractures. The other two studies validated existing treatment regimens. Overall, surgical treatment of dislocated fractures and conservative treatment of non-dislocated fractures was carried out with satisfactory results. The outcome of conservative treatment of dislocated factures remains unclear. A reason for the inconsistent treatment results could be the observed concomitant injuries, including dislocation of the tendons of the peroneus muscles (46%), calcaneal chondral injuries (48%) and subluxation of the subtalar joint (7%). Based on the limited evidence available, the authors recommend the application of CT and MRI for PLT fractures to assess concomitant injuries, which are the primary indication for surgery. Dislocated type I and II fractures (>2 mm) should be treated operatively, type III and non-dislocated type I and II fractures can be treated conservatively by immobilization and partial weight-bearing for 6 weeks.
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Affiliation(s)
- H Hörterer
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland.
- PMU Salzburg, Strubergasse 21, 5020, Salzburg, Österreich.
| | - S F Baumbach
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - A T Mehlhorn
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - S Altenberger
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - A Röser
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - H Polzer
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - M Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
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Massen FK, Baumbach SF, Böcker W, Kammerlander C, Herterich V, Polzer H. [Fractures of the anterior process of the calcaneus-frequently overlooked injuries following ankle sprains]. Unfallchirurg 2018; 121:730-738. [PMID: 29845370 DOI: 10.1007/s00113-018-0514-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures to the anterior process of the calcaneus (PAC) have long been considered rare injuries and have received little attention in clinical research. On the contrary, recent studies have reported a distinct higher incidence, especially following ankle sprains. Decisive reasons are that fractures of the PAC are regularly missed on plain radiographs and that a clinical differentiation from injuries to the lateral ankle ligaments is difficult. With the broad availability of cross-sectional imaging modalities fractures of the PAC are diagnosed more frequently and more reliably. The purpose of this review is to give an overview on the diagnostics, classification and treatment recommendations to this topic and discuss the studies available. To date no evidence-based recommendations are available for the treatment of fractures of the PAC. The few case reports and case series published, predominantly recommend conservative treatment; however, the treatment regimens vary considerably, ranging from immobilization in a lower leg cast (2-10 weeks) to early functional treatment with full weight-bearing. The surgical treatment by open reduction and internal fixation has been described primarily for large dislocated fractures. Surgical excision is considered mainly in cases of persistent pain or symptomatic non-union following non-operative treatment. For both, non-operative and operative treatment, the case reports and case series report satisfactory outcomes for the majority of patients. Nevertheless, comparative studies and patient-rated outcome measures are missing. Therefore, evidence-based recommendations cannot be given.
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Affiliation(s)
- F K Massen
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - S F Baumbach
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - C Kammerlander
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - V Herterich
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - H Polzer
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.
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Baumbach SF, Stawinski T, Schmitz D, Schoeneberg C, Jäger M, Wedemeyer C, Kauther MD. Influence of kitesurf equipment on injury rates. J Sports Med Phys Fitness 2017; 58:1482-1489. [PMID: 28738666 DOI: 10.23736/s0022-4707.17.07152-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Various injuries in kitesurfing (KS) have been reported so far. The aim of this study was to validate the effect of different kite designs and safety equipment on the injury rate compared to older studies. METHODS A retrospective epidemiological study based on an anonymous face-to-face survey was conducted amongst active kitesurfers. The questionnaire consisted of 66 questions focusing on the equipment used, injury rates, overuse injuries and gender differences. A stepwise Poisson-Model was used to identify injury-associated factors. RESULTS A total of 202 kitesurfers with a mean age of 31.8±9.1 years and 698.2±931.5 hours of KS experience were included. 2613 injuries were recorded (18.5/1000 hours KS). Almost 50% were hematomas, bruises or cuts. 3.9% of all injuries (0.71/1000 hours KS) were time-loss injuries of more than one week. Female kitesurfers had a significantly greater injury rate, were less experienced and fewer of them used C-kites. Height, weight, primary kite spot, experience, physical activity, warm-up/stretching, the type of kite and control bar used, and the use of a board leash were independent factors associated to injury rate. The lower extremity, the elbow, thorax and abdomen were at risk for overuse injuries. CONCLUSIONS An influence of equipment on injuries could be statistically shown. The overall injury rate in KS did not decline in the last decades, but time-loss injuries did.
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Affiliation(s)
- Sebastian F Baumbach
- Department of Hand-, Plastic- and Trauma Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Tanja Stawinski
- Department of Orthopedics and Trauma Surgery Orthopedics, University Hospital Essen, Essen, Germany
| | - Daniel Schmitz
- Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Carsten Schoeneberg
- Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Marcus Jäger
- Department of Orthopedics and Trauma Surgery Orthopedics, University Hospital Essen, Essen, Germany
| | - Christian Wedemeyer
- Department of Orthopedics and Trauma Surgery, St. Barbara Hospital, Gladbeck, Germany
| | - Max D Kauther
- Department of Orthopedics and Trauma Surgery Orthopedics, University Hospital Essen, Essen, Germany -
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Baumbach SF, Binder J, Synek A, Mück FG, Chevalier Y, Euler E, Langs G, Fischer L. Analysis of the three-dimensional anatomical variance of the distal radius using 3D shape models. BMC Med Imaging 2017; 17:23. [PMID: 28274212 PMCID: PMC5343417 DOI: 10.1186/s12880-017-0193-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Various medical fields rely on detailed anatomical knowledge of the distal radius. Current studies are limited to two-dimensional analysis and biased by varying measurement locations. The aims were to 1) generate 3D shape models of the distal radius and investigate variations in the 3D shape, 2) generate and assess morphometrics in standardized cut planes, and 3) test the model's classification accuracy. METHODS The local radiographic database was screened for CT-scans of intact radii. 1) The data sets were segmented and 3D surface models generated. Statistical 3D shape models were computed (overall, gender and side separate) and the 3D shape variation assessed by evaluating the number of modes. 2) Anatomical landmarks were assigned and used to define three standardized cross-sectional cut planes perpendicular to the main axis. Cut planes were generated for the mean shape models and each individual radius. For each cut plane, the following morphometric parameters were calculated and compared: maximum width and depth, perimeter and area. 3) The overall shape model was utilized to evaluate the predictive value (leave one out cross validation) for gender and side identification within the study population. RESULTS Eighty-six radii (45 left, 44% female, 40 ± 18 years) were included. 1) Overall, side and gender specific statistical 3D models were successfully generated. The first mode explained 37% of the overall variance. Left radii had a higher shape variance (number of modes: 20 female / 23 male) compared to right radii (number of modes: 6 female / 6 male). 2) Standardized cut planes could be defined using anatomical landmarks. All morphometric parameters decreased from distal to proximal. Male radii were larger than female radii with no significant side difference. 3) The overall shape model had a combined median classification probability for side and gender of 80%. CONCLUSIONS Statistical 3D shape models of the distal radius can be generated using clinical CT-data sets. These models can be used to assess overall bone variance, define and analyze standardized cut-planes, and identify the gender of an unknown sample. These data highlight the potential of shape models to assess the 3D anatomy and anatomical variance of human bones.
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Affiliation(s)
- Sebastian F Baumbach
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Nussbaumstr. 20, Munich, 80336, Germany.
| | - Jakob Binder
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Nussbaumstr. 20, Munich, 80336, Germany
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, Vienna, 1060, Austria
| | - Fabian G Mück
- Department of Clinical Radiology, University Hospital LMU Munich, Nussbaumstr. 20, Munich, 80336, Germany
| | - Yan Chevalier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Campus Grosshadern, Marchioninistraße 15, Munich, 81377, Germany
| | - Ekkehard Euler
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Nussbaumstr. 20, Munich, 80336, Germany
| | - Georg Langs
- Computational Imaging Research Laboratory, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Lukas Fischer
- Computational Imaging Research Laboratory, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Software Competence Center Hagenberg GmbH, Softwarepark 21, Hagenberg, 4232, Austria
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Baumbach SF, Braunstein M, Regauer M, Böcker W, Polzer H. Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination. J Vis Exp 2016. [PMID: 27500825 DOI: 10.3791/53446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20° of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20° flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.
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Affiliation(s)
- Sebastian F Baumbach
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | - Mareen Braunstein
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | - Markus Regauer
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | | | - Hans Polzer
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital;
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Baumbach SF, Braunstein M, Polzer H. Letter Regarding: Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia. Foot Ankle Int 2016; 37:790-1. [PMID: 27440057 DOI: 10.1177/1071100716654966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Braunstein M, Baumbach SF, Regauer M, Böcker W, Polzer H. The value of arthroscopy in the treatment of complex ankle fractures - a protocol of a randomised controlled trial. BMC Musculoskelet Disord 2016; 17:210. [PMID: 27175917 PMCID: PMC4865995 DOI: 10.1186/s12891-016-1063-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/07/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND An anatomical reconstruction of the ankle congruity is the important prerequisite in the operative treatment of acute ankle fractures. Despite anatomic restoration patients regularly suffer from residual symptoms after these fractures. There is growing evidence, that a poor outcome is related to the concomitant traumatic intra-articular pathology. By supplementary ankle arthroscopy anatomic reduction can be confirmed and associated intra-articular injuries can be treated. Nevertheless, the vast majority of complex ankle fractures are managed by open reduction and internal fixation (ORIF) only. Up to now, the effectiveness of arthroscopically assisted fracture treatment (AORIF) has not been conclusively determined. Therefore, a prospective randomised study is needed to sufficiently evaluate the effect of AORIF compared to ORIF in complex ankle fractures. METHODS/DESIGN We perform a randomised controlled trial at Munich University Clinic enrolling patients (18-65 years) with an acute ankle fracture (AO 44 A2, A3, B2, B3, C1 - C3 according to AO classification system). Patients meeting the inclusion criteria are randomised to either intervention group (AORIF, n = 37) or comparison group (ORIF, n = 37). Exclusion criteria are fractures classified as AO type 44 A1 or B1, pilon or plafond-variant injury or open fractures. Primary outcome is the AOFAS Score (American Orthopaedic Foot and Ankle Society). Secondary outcome parameter are JSSF Score (Japanese Society of Surgery of the Foot), Olerud and Molander Score, Karlsson Score, Tegner Activity Scale, SF-12, radiographic analysis, arthroscopic findings of intra-articular lesions, functional assessments, time to return to work/sports and complications. This study protocol is accordant to the SPIRIT 2013 recommendation. Statistical analysis will be performed using SPSS 22.0 (IBM). DISCUSSION The subjective and functional outcome of complex ankle fractures is regularly unsatisfying. As these injuries are very common it is essential to improve the postoperative results. Potentially, arthroscopically assisted fracture treatment can significantly improve the outcome by addressing the intra-articular pathologies. Given the absolute lack of studies comparing AORIF to ORIF in complex ankle fractures, this randomised controlled trail is urgently needed to evaluate the effectiveness of additional arthroscopy. TRIAL REGISTRATION ClinicalTrials.gov reference: NCT02449096 (Trial registration date: April 7th, 2015).
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Affiliation(s)
- Mareen Braunstein
- Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University Munich, Nußbaumstr 20, Munich, 80336, Germany.
| | - Sebastian F Baumbach
- Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University Munich, Nußbaumstr 20, Munich, 80336, Germany
| | - Markus Regauer
- Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University Munich, Nußbaumstr 20, Munich, 80336, Germany
| | - Wolfgang Böcker
- Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University Munich, Nußbaumstr 20, Munich, 80336, Germany
| | - Hans Polzer
- Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University Munich, Nußbaumstr 20, Munich, 80336, Germany
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Synek A, Borgmann L, Traxler H, Huf W, Euler E, Chevalier Y, Baumbach SF. Using self-drilling screws in volar plate osteosynthesis for distal radius fractures: a feasibility study. BMC Musculoskelet Disord 2016; 17:120. [PMID: 26966085 PMCID: PMC4785720 DOI: 10.1186/s12891-016-0972-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/03/2016] [Indexed: 11/30/2022] Open
Abstract
Background Symptomatic extensor tendon irritation is a frequent complication in volar plate osteosynthesis of distal radius fractures. It is typically caused by dorsal screw protrusion and overdrilling of the dorsal cortex. The use of self-drilling locking screws (SDLS) could overcome both causes. The practical applicability of SDLS depends on two prerequisites: (1) the feasibility of preoperative distal screw length determination, and (2) sufficient primary biomechanical stability of SDLS compared to standard locking screws (SLS). Methods We first assessed the feasibility of preoperative screw length determination (1): Distal radius width, depth and distal screw lengths were measured in 38 human radii. Correlations between distal radius width and depth were assessed, a cluster analysis (Ward’s method and squared Euclidean distance) for distal radius width conducted, and intra-cluster screw lengths analyzed (ANOVA). The biomechanical performance of SDLS (2) was assessed by comparison to SLS in a distal radius fracture model (AO-23 A3). 75 % distal screw length was chosen for both groups to simulate a worst-case scenario. Uniaxial compression tests were conducted to measure stiffness, elastic limit, maximum force and residual tilt. Statistics comprised of independent sample t-tests and a Bonferroni correction (p < 0.0125). Results (1) Distal radius width and depth showed a high correlation (R2 = 0.79; p < 0.001). Three distal radius width clusters could be identified: small <34 mm; medium 34–36.9 mm; large >36.9 mm. ANOVA and Tukey post-hoc analysis revealed significantly different volar-dorsal depths (p < 0.05) for nearly all screws. (2) To assess biomechanical stability nine specimens were tested each; no significant differences were found between the SDLS and SLS groups. Conclusions This feasibility study demonstrates that (1) distal radius width can be used as a predictor for distal screw length and (2) that SDLS provides mechanical stability equivalent to SLS. These results highlight the feasibility of applying SDLS screws in volar plate osteosynthesis at least in extraarticular fractures.
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Affiliation(s)
- Alexaner Synek
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria
| | - Lars Borgmann
- Center for Higher Education, TU Dortmund University, Dortmund, Germany
| | - Hannes Traxler
- Center of Anatomy and Cell Biology, Department of Systematic Anatomy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Huf
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ekkehard Euler
- Department of Trauma Surgery, Campus Innenstadt, Ludwig-Maximilians-University, Nussbaumstrasse 20, 80336, Munich, Germany
| | - Yan Chevalier
- Department of Orthopedic Surgery, Laboratory for Biomechanics and Experimental Orthopedics, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Sebastian F Baumbach
- Department of Trauma Surgery, Campus Innenstadt, Ludwig-Maximilians-University, Nussbaumstrasse 20, 80336, Munich, Germany.
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Baumbach SF, Synek A, Traxler H, Mutschler W, Pahr D, Chevalier Y. The influence of distal screw length on the primary stability of volar plate osteosynthesis--a biomechanical study. J Orthop Surg Res 2015; 10:139. [PMID: 26351239 PMCID: PMC4563846 DOI: 10.1186/s13018-015-0283-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Extensor tendon irritation is one of the most common complications following volar locking plate osteosynthesis (VLPO) for distal radius fractures. It is most likely caused by distal screws protruding the dorsal cortex. Shorter distal screws could avoid this, yet the influence of distal screw length on the primary stability in VLPO is unknown. The aim of this study was to compare 75 to 100 % distal screw lengths in VLPO. Methods A biomechanical study was conducted on 11 paired fresh-frozen radii. HRpQCT scans were performed to assess bone mineral density (BMD) and bone mineral content (BMC). The specimens were randomized pair-wise into two groups: 100 % (group A) and 75 % (group B) unicortical distal screw lengths. A validated fracture model for extra-articular distal radius fractures (AO-23 A3) was used. Polyaxial volar locking plates were mounted, and distal screws was inserted using a drill guide block. For group A, the distal screw tips were intended to be flush or just short of the dorsal cortex. In group B, a target screw length of 75 % was calculated. The specimens were tested to failure using a displacement-controlled axial compression test. Primary biomechanical stability was assessed by stiffness, elastic limit, and maximum force as well as with residual tilt, which quantified plastic deformation. Results Nine specimens were tested successfully. BMD and BMC did not differ between the two groups. The mean distal screw length of group A was 21.7 ± 2.6 mm (range: 16 to 26 mm), for group B 16.9 ± 1.9 mm (range: 12 to 20 mm). Distal screws in group B were on average 5.6 ± 0.9 mm (range: 3 to 7 mm) shorter than measured. No significant differences were found for stiffness (706 ± 103 N/mm vs. 660 ± 124 N/mm), elastic limit (177 ± 25 N vs. 167 ± 36 N), maximum force (493 ± 139 N vs. 471 ± 149 N), or residual tilt (7.3° ± 0.7° vs. 7.1° ± 1.3°). Conclusion The 75 % distal screw length in VLPO provides similar primary stability to 100 % unicortical screw length. This study, for the first time, provides the biomechanical basis to choose distal screws significantly shorter then measured. Electronic supplementary material The online version of this article (doi:10.1186/s13018-015-0283-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian F Baumbach
- Department of Trauma Surgery, University Hospital of Munich (LMU), Campus Innenstadt, Nußbaumstrasse 20, 80336, Munich, Germany.
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria
| | - Hannes Traxler
- Center of Anatomy and Cell Biology, Department of Systematic Anatomy, Medical University Vienna, Währinger Straße 13, 1090, Vienna, Austria
| | - Wolf Mutschler
- Department of Trauma Surgery, University Hospital of Munich (LMU), Campus Innenstadt, Nußbaumstrasse 20, 80336, Munich, Germany
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 15, 81377, Munich, Germany
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Baumbach SF, Polzer H. Letter to the editor on "Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations". Foot Ankle Surg 2015; 21:224-5. [PMID: 26235870 DOI: 10.1016/j.fas.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/11/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Sebastian F Baumbach
- Munich University Hospital, Department of Trauma Surgery - Campus Innenstadt, LMU Nussbaumstr. 20, 80336 Munich, Germany
| | - Hans Polzer
- Munich University Hospital, Department of Trauma Surgery - Campus Innenstadt, LMU Nussbaumstr. 20, 80336 Munich, Germany.
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Boesmueller S, Baumbach SF, Hofbauer M, Wozasek GE. Plate failure following plate osteosynthesis in periprosthetic femoral fractures. Wien Klin Wochenschr 2015; 127:770-8. [PMID: 26187336 DOI: 10.1007/s00508-015-0818-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing numbers of total knee and hip arthroplasties result in a growing number of periprosthetic femoral fractures (PPFF). PPFF with a stable stem component are treated commonly with plate osteosynthesis. Therefore plate failure is seen as a major complication. The aim of this retrospective study was to investigate the patients' outcome after plate failure. METHODS The database of a Level 1 trauma center was searched for all patients treated for a PPFF with plate osteosynthesis. Patients with plate failure were investigated specifically. Standard demographic data, details on initial arthroplasty, trauma, and treatment were recorded for all patients. All fractures were classified and their outcome reviewed. RESULTS Seven (8.8%) out of 80 patients treated with plate osteosynthesis following PPFF met our inclusion criterion being plate failure. All these patients were female, with an average age at primary surgery of 74 ± 13 years and a mean follow-up of 885 days (range, 264-2549). Four patients suffered a PPFF after total hip arthroplasty (THA) (2 Vancouver Type B1 and 2 Type C) and three after total knee arthroplasty (TKA) (Lewis-Rorabeck Type II). Following plate failure, four patients healed uneventfully and three patients experienced complications such as pseudarthrosis, screw loosening, and further plate failure. CONCLUSION In patients with poor bone quality, bone graft, bone cement, and bone biologics have to be considered in revision surgery. Furthermore, long-stem revision and tumor prosthesis are an additional solution.
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Affiliation(s)
- Sandra Boesmueller
- Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Sebastian F Baumbach
- Department of Trauma Surgery-Campus Innenstadt, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marcus Hofbauer
- Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerald E Wozasek
- Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Sommerey S, Foroghi Y, Chiapponi C, Baumbach SF, Hallfeldt KKJ, Ladurner R, Gallwas JKS. Laparoscopic adrenalectomy—10-year experience at a teaching hospital. Langenbecks Arch Surg 2015; 400:341-7. [DOI: 10.1007/s00423-015-1287-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
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Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. Injury 2014; 45:1782-90. [PMID: 25059505 DOI: 10.1016/j.injury.2014.06.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/29/2014] [Indexed: 02/02/2023]
Abstract
The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied.
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Affiliation(s)
- Mareen Brumann
- Munich University Hospital, Department of Trauma Surgery, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336 Munich
| | - Sebastian F Baumbach
- Munich University Hospital, Department of Trauma Surgery, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336 Munich
| | - Wolf Mutschler
- Munich University Hospital, Department of Trauma Surgery, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336 Munich
| | - Hans Polzer
- Munich University Hospital, Department of Trauma Surgery, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336 Munich.
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Baumbach SF, Brumann M, Binder J, Mutschler W, Regauer M, Polzer H. The influence of knee position on ankle dorsiflexion - a biometric study. BMC Musculoskelet Disord 2014; 15:246. [PMID: 25053374 PMCID: PMC4118219 DOI: 10.1186/1471-2474-15-246] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculus gastrocnemius tightness (MGT) can be diagnosed by comparing ankle dorsiflexion (ADF) with the knee extended and flexed. Although various measurement techniques exist, the degree of knee flexion needed to eliminate the effect of the gastrocnemius on ADF is still unknown. The aim of this study was to identify the minimal degree of knee flexion required to eliminate the restricting effect of the musculus gastrocnemius on ADF. METHODS Bilateral ADF of 20 asymptomatic volunteers aged 18-40 years (50% female) was assessed prospectively at six different degrees of knee flexion (0°, 20°, 30°, 45°, 60°, 75°, Lunge). Tests were performed following a standardized protocol, non weightbearing and weightbearing, by two observers. Statistics comprised of descriptive statistics, t-tests, repeated measurement ANOVA and ICC. RESULTS 20 individuals with a mean age of 27 ± 4 years were tested. No significant side to side differences were observed. The average ADF [95% confidence interval] for non weightbearing was 4° [1°-8°] with the knee extended and 20° [16°-24°] for the knee 75° flexed. Mean weightbearing ADF was 25° [22°-28°] for the knee extended and 39° [36°-42°] for the knee 75° flexed. The mean differences between 20° knee flexion and full extension were 15° [12°-18°] non weightbearing and 13° [11°-16°] weightbearing. Significant differences of ADF were only found between full extension and 20° of knee flexion. Further knee flexion did not increase ADF. CONCLUSION Knee flexion of 20° fully eliminates the ADF restraining effect of the gastrocnemius. This knowledge is essential to design a standardized clinical examination assessing MGT.
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Affiliation(s)
- Sebastian F Baumbach
- Department of Trauma Surgery - Campus Innenstadt, Munich University Hospital, Nussbaumstr, 20, 80336 Munich, Germany.
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Baumbach SF, Domaszewski F, Wyen H, Kalcher K, Mutschler W, Kanz KG. Evaluation of the current treatment concepts in Germany, Austria and Switzerland for acute traumatic lesions to the prepatellar and olecranon bursa. Injury 2013; 44:1423-7. [PMID: 22980398 DOI: 10.1016/j.injury.2012.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/31/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although traumatic lacerations of the olecranon (OB) and praepatellar bursae (PB) are common entities often associated with complications, no study could be found on this injury. The aim of this study was to survey the current treatment concepts for acute traumatic laceration of the OB and PB in Germany, Austria and Switzerland. MATERIALS AND METHODS An international online survey was conducted among orthopaedic and trauma surgeons in Germany (TraumaNetwork DGU), Austria (Austrian Society of Trauma (ÖGU) and Orthopaedic (ÖGO) Surgeons) and Switzerland (Swiss Orthopaedic Surgeons and Swiss Society of Infectious Disease (CH)) (n=1967). The survey comprised of five demographical questions, the current treatment concepts were evaluated using a case study. RESULTS The overall-response-rate was 16% (12-46%). 88% of the responding physicians were male, aged 47.5 ± 10.2 years with a mean working experience of 20.1 ± 10.6 years. 54% of the surveyed physicians were either senior or chief physicians. Treatment concepts varied significantly between DGU and ÖGO/CH (p=0.02/p=0.006), no significant differences could be found between DGU and ÖGU. Generally, German and Austrian trauma surgeons favoured bursectomy (86.7%/90.9%) and immobilisation (68.3%/77.3%). Austrian orthopaedic surgeons performed fewer bursectomies (69.3%) but had the highest proportion for administering antibiotics (73.9%). Less than 50% of Swiss physicians indicated bursectomy as a treatment option. CONCLUSION Overall, this survey revealed a significant heterogeneity in treatment approaches in Central Europe. Further evidence is needed to identify the best treatment concepts for traumatic lacerations of the OB and PB.
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Affiliation(s)
- Sebastian F Baumbach
- Department of Trauma Surgery - Campus Innenstadt, Ludwig-Maximilians-University Munich, Nussbaumstrasse 20, 80336 Munich, Germany.
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Baumbach SF, Krusche-Mandl I, Huf W, Mall G, Fialka C. Linear intra-bone geometry dependencies of the radius: radius length determination by maximum distal width. Eur J Radiol 2011; 81:947-50. [PMID: 21498015 DOI: 10.1016/j.ejrad.2011.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 02/11/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to investigate possible linear intra-bone geometry dependencies by determining the relation between the maximum radius length and maximum distal width in two independent populations and test for possible gender or age effects. A strong correlation can help develop more representative fracture models and osteosynthetic devices as well as aid gender and height estimation in anthropologic/forensic cases. METHODS First, maximum radius length and distal width of 100 consecutive patients, aged 20-70 years, were digitally measured on standard lower arm radiographs by two independent investigators. Second, the same measurements were performed ex vivo on a second cohort, 135 isolated, formalin fixed radii. Standard descriptive statistics as well as correlations were calculated and possible gender age influences tested for both populations separately. RESULTS The radiographic dataset resulted in a correlation of radius length and width of r=0.753 (adj. R(2)=0.563, p<0.001) with sex having a significant (p=0.005, adj. R(2)=0.592) and side no influence on the correlation. Radius length-width correlation for the isolated radii was r=0.621 (adj. R(2)=0.381, p<0.001) with sex significantly influencing this correlation (p<0.001, adj. R(2)=0.598). CONCLUSION A relatively strong radius length-distal width correlation was found in two different populations, indicating that linear body proportions might not only apply to body height and axial length measurements of long bones but also to proportional dependency of bone shapes in general.
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Affiliation(s)
- S F Baumbach
- Medical University of Vienna, Department of Traumatology, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Jeng CL, Baumbach SF, Campbell J, Kalesan B, Myerson MS. Comparison of initial compression of the medial, lateral, and posterior screws in an ankle fusion construct. Foot Ankle Int 2011; 32:71-6. [PMID: 21288437 DOI: 10.3113/fai.2011.0071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the requirements for successful ankle arthrodesis is adequate compression by the fixation across the fusion surfaces. A common screw construct for ankle fusion is three crossed screws from proximal-to-distal. Because the screws are inserted nearly orthogonal to each other, it is possible minimal additional compression is obtainable once the first screw is inserted. The aim of this study was to determine which of the three screws gave the greatest initial compression and theoretically should be inserted first. MATERIALS AND METHODS Seventeen cadaver limbs were dissected to expose the anterior and posterior aspects of the tibiotalar joint. Three Fuji film templates were created for each ankle joint with a hole to accommodate a 7.0-mm cannulated screw. Each film was tested with a single medial, lateral, or posterior screw. The Fuji films were then analyzed for contact area, percent contact area, and pressure. RESULTS There was no difference in the total contact area, percent contact area, or pressure generated between the three screws. The mean contact area for all screws was 11% of the joint surface. All three screws had greater contact area and percent contact area over the anterior half of the ankle joint. CONCLUSION The medial, lateral, and posterior screws were equivalent with respect to contact area, percent contact area, and pressure generated across the tibiotalar joint. All three screws had greater contact area over the anterior half of the joint. Only 11% of the tibiotalar joint surface came in contact following the insertion of a single partially threaded screw. CLINICAL RELEVANCE In a neutrally aligned ankle arthrodesis the order of screw insertion does not affect the amount of compression ultimately achieved at the fusion site.
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Affiliation(s)
- Clifford L Jeng
- Mercy Medical Center, Institute for Foot and Ankle Reconstruction, 301 St. Paul Place, Baltimore, MD 21202, USA.
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